The complex healthcare system has faced a range of challenges over the past. In this regard, the most affected group of healthcare providers in the industry are nurses. According to the Institute of Medicine (2010), nurses represent the biggest segment of providers in the healthcare industry, totaling to more than 3 million practicing nurses. In this regard, the complexities and barriers existing in the system hinder the effective performance of nurses in healthcare delivery to the population. In an effort to improve the quality of healthcare, the government, through the 2010 Affordable Care Act, aimed to introduce drastic changes, almost an overhaul, to the healthcare industry. In this regard, massive changes were proposed, in which case some are already on course, an aspect that was highlighted to affect nurses, and providers who are on the frontline of patient care.
In order to ensure the healthcare industry was ready to support the recommended changes, more specifically with regards to the field of nursing, the Institute of Medicine (IOM) and Robert Wood Johnson Foundation (RWJF) instituted a commission to discuss the future of the profession. In this regard, the emerging commission report focused on the areas, nursing practice, workforce development, and nursing education as discussed further below:
Nursing Practice
The IOM recognizes that nurses have tremendous potential of improving the current health status of the population. However, various barriers such as regulatory, structural, and social-economic challenges affecting patients hinder the successful exploitation of the nursing practice. In this regard, the report features the essential role played by nurses in recognition of their different serving capacities such as nurse scientists, practical nurses, and licensed Registered Nurses (RNs). Following the expected changes in the industry, the commission recommended a different approach in healthcare delivery, that of interdisciplinary collaboration. In this case, nursing leadership is emphasized to equip nurses with skills required to provide quality healthcare and advance their careers. In this regard, collaboration with other professionals such as physicians, social workers, and other healthcare providers is considered paramount in redesigning care and ensuring the provision of quality healthcare.
Having a "full-partner" status with other healthcare professionals means that nurses are involved in decision-making, identification of any system waste and the implementation of suitable plans to combat such waste and inefficiencies in the healthcare system. In addition, taking up leadership positions in the industry mean that nurses are engaged in policy development and implementation processes following their involvement in advisory boards.
These concepts are further supported by the aspect that nurses should be allowed to practice to the full extent of their education and training. This approach will enable nurses to provide care to patients in the best possible way hence ensuring the quality of healthcare provision.
Nursing Education
The academic qualifications in nursing offer nurses opportunity to be involved in the provision of care. According to IOM (2010), the majority of nurses are Registered Nurses (RNs, practicing in different states of the country. However, the profession has registered a growing interest of individuals who have progressed academically, becoming Advanced Practice Registered Nurses (APRNs), while others have gone further and specialized in specific areas such as anesthetists, midwives, amongst others.
As a result of the expected changes in the healthcare industry, the emphasis on the quality of nursing education has become paramount. Additionally, the growing complexity of diseases has prompted the need for experienced nurses who can manage any developments in the nature of illnesses. As such, the education system should be arraigned in a similar manner, allowing nursing students to grow their knowledge and practical experiences.
However, the expression of nursing education and training is hampered by regulations and legislative considerations. In this case, rules pertaining to nursing practice and licensing vary across different states in the country. In this regard, varying rules of the scope of practice which provide the confines of nursing practice have different effects on varying types of nurses available in parts of the country. The boundaries which nurses are allowed to practice are not determined by education or training but rather, state regulations.
In this case, according to the recommendations provided by the IOM report, the nursing education system should be improved to facilitate a seamless transition from one academic level to the next. In consideration of increasing complexity of patient needs, the report calls for nurses to achieve higher educational levels to deal with this emerging trend. Moreover, the report recommends the need for nurses to learn together with other health professionals such as physicians, to integrate their learning experiences and enhance comprehension of patient needs and improve the quality of health care.
Nursing Workforce Development
The United States is a mixing pot of cultures that express the rich diversity of the country. As such, healthcare providers should represent a similar aspect, particularly to nurses, to establish positive ties with the communities they work in. In this regard, a diverse workforce can deliver adequate and quality healthcare to the nation’s population and also encourage a proper culture of health. As such, the increase in the number of nurses from different ethnicities and backgrounds is identified as a means to improve healthcare quality and accessibility to a large number of patients.
As identified above, the healthcare industry through the implementation of the ACA is projected to experience drastic changes. In this regard, the nursing workforce will be ultimately affected by the changes thereby providing the need for workforce development as per the IOM report. In order to plan for these projected changes, there is a need for comprehensive data on the current workforce composition, in consideration of the number and types of healthcare professionals in the present system. As such, planning and establishment of a proper information infrastructure to collect and analyze data is of paramount importance. This aspect will provide for the systematic assessment of the workforce regarding roles, skill sets, demographics, and regions will be considered to inform impending changes in the nursing workforce.
The 2010 ACA considers the establishment of both the National Healthcare Workforce Commission and the National Center for Workforce Analysis as integral components in the expected changes in the healthcare industry. The former seeks to determine the workforce demand as per implementation of proposed changes, while the latter is concerned with the collection of relevant workforce data and analysis of the same. In this regard, the report recommends the need for these programs to adapt accurate data collection methods and analysis to determine the workforce needs and demands accurately.
The establishment of the Action Coalitions is in line with recommendations of the IOM report. In this regard, these are organizations comprised of stakeholders drawn from different areas of the health spectrum such as nurses and business partners to advance healthcare at the local level. In this case, these coalitions mobilize efforts at grassroots levels to achieve a healthier population in communities statewide.
The ultimate goal of the Campaign for Action is to facilitate a healthier population. In order to achieve this feat, the action coalitions connect with communities at local levels thereby enhancing comprehension of the residents’ health needs. As such, they mobilize efforts from nurses, educators, consumers, and health providers to strengthen the nursing practice on various fronts.
California Action Coalition
As indicated above, Action Coalitions focus on identifying and addressing health care needs at the grassroots level. In this regard, California is one of the State Action Coalition, which is geared towards achieving progress in nursing practice. Owing to the wide variety of changes already experienced as a result of healthcare reforms, California has aimed to initiate quality health care and accessibility to affordable care to its residents. In this regard, the CA AC is geared towards achieving its vision of ensuring a healthy state in regards to nursing leadership and practice, similar premises to those of Campaign for Action.
The two initiatives spearheaded by the CA AC are in nursing education and practice as expounded further below:
Nursing Education
The CA AC aims at fulfilling recommendations of the IOM report in California. One of these propositions is to increase the number of nurses with baccalaureate degrees by eighty percent by the year 2020. This recommendation is in line with the realization that the expected changes in the healthcare industry require competent, knowledgeable, and experienced nurses to deal with the emerging treatments and trends in the industry.
In this regard, California has fared well, registering impressive results as it progresses towards the achievement of this goal. According to the California Action Coalition, the consideration of a collaborative approach to promoting nursing education is viewed as the best strategy to facilitate fulfillment of this aspect. In this case, this model has registered positive results as it has ensured a seamless transition for nurses and nursing students from ADN to BSN degrees. This concept has been grounded by collaborations between community colleges in California and BSN offering universities. This strategy has led to the establishment of partnerships with 20 universities and 61 community colleges (Health Impact, 2015). Furthermore, 6% California ADN students have been able to progress to the BSN level in this arrangement.
In order to enable nursing students to obtain requisite training and experience in the course of their education, nursing schools in California have embraced the Centralized Clinical Placement System that allows for the facilitation of clinical placement of nursing students. This system is a one-stop portal which is responsible for linking schools and clinical facilities. The CCPS was started in California and has since been licensed to other states.
California has embraced transition programs that aim at equipping new graduates as well as experienced nurses with the requisite skills and knowledge required in navigating the changing healthcare landscape. In this case, schools and clinical facilities collaborate to provide a practical experience to students in one or more sites, through a nursing school. According to Health Impact (2015), this program has led to RN graduate students registering high confidence and competency levels, thereby increasing their employability than those who do not participate in the program.
The advancement in nursing education as promoted by the CA AC means that the practice is equipped with necessary skills and qualifications to meet any emerging needs in healthcare. In this regard, owing to the expected changes as a result of healthcare reforms means that the state’s nursing workforce is ready to meet the forthcoming challenge without compromising on quality healthcare.
Nursing Practice
Over the years, the complexity of the healthcare system has influenced nursing performance leading to inadequate quality in service provision. In this regard, nurses had their hands tied regarding ensuring patients received quality healthcare as a result of existing policy and legislative barriers. In this regard, the drastic changes expected from the implementation of the 2010 Affordable Care Act calls for the need to re-evaluate the practice to ensure it is well-aligned with expected service delivery (Campaign for Action, n.d).
One of the aspects affecting the practice has been a lack of diversity in the workforce. As a result, healthcare institutions have not been able to establish viable and positive ties with the surrounding communities, thereby hampering the provision of adequate and quality health care. However, this aspect is bound to change as a result of the implementation of the recommendations agreed to in the IOM report. In this regard, CA AC recognizes that there is a need to have a diverse workforce that is reflective of the diverse nature of the state. Concerning gender, the number of male nurses has increased by 4.4% from the year 2004 to 2014 (Health Impact, 2015). The state has also registered a similar increase in the number of nurses from other ethnicities such as Filipino, Hispanic, and Black students.
As mentioned above, one of the main barriers to nursing practice stems from legislative considerations that limit nurses’ ability to practice in full service to patients. California has been grappled by this challenge as it seeks to facilitate an adequate scope of practice for nurses. One of the recommendations, as stipulated in the IOM report, is to remove barriers that affect nurses’ scope of practice. In this regard, the CA AC aims to identify opportunity areas which nurses can best practice along the borders of California Law and Statue, also in the state Nurse Practice Act.
The adoption of effective strategies in consideration of the nursing scope of practice will progress the profession in that nurses will be able to accord care to patients in the most convenient manner possible. For instance, the provision that nurses can work without the oversight of a doctor means that patients can get immediate attention in their healthcare leading to increased patient satisfaction.
The promotion of nursing leadership is considered a viable option for managing the challenges confronting the CA AC. In this regard, nursing advocates can provide suitable policy plans. It also assists in their implementation to promote the practice through eradication of cultural and structural barriers.
Barriers in California Healthcare System
As indicated above, the primary barrier in the system is in consideration of the nursing practice. According to Beamish (n.d), California is one of the states where nurses cannot operate independently without consultations with an oversight doctor. This situation translates to an extra layer of unnecessary paperwork, sign-offs, and supervision. In some instances, patients are required to travel further to get healthcare assistance or else they are forced to deal with impending delays as a result of this aspect.
References
Beamish, R. (n.d). Nurses seek larger role in primary care. AARP California. Retrieved from http://states.aarp.org/ca-nurses/
Campaign for Action (n.d). California Action Coalition. Retrieved from http://campaignforaction.org/state/california/
Health Impact (2015). Annual report. Retrieved from http://healthimpact.org/wp-content/uploads/2016/03/healthimpact_ar2015_web_final1.pdf
